TABLE 2.

Administrative Data-Based Quality Indicator Performance–Community-Based Population of Dual Eligible Enrollees Age 75 Years and Older

Eligible Patient Age 75 Yr and Older	QI Recommended Care Process	Contraindications and Exclusions	Total Eligible (#)	Passed (#)	Passed (%)
Patient discharged from hospital	Follow-up appointment within 6 wk	–	32,792	24,921	76.0
Patient with newly diagnosed dementia	Perform serum B12 & TSH level	–	8889	665	7.5
Patient with newly diagnosed dementia	Receive cholinesterase inhibitor	–	10,486	1387	13.2
Patient with dementia and new depression	Treat depression with pharmacologic therapy or mental health referral	–	1178	235	19.9
Patient with new depression diagnosis	Treat with pharmacologic therapy or mental health referral within 2 wk	–	3963	903	22.8
Patient newly treated with an antidepressant	Do not prescribe TCAs, MAOIs, benzodiazepines, or stimulants as 1st or 2nd line therapy	–	694	619	89.2
Patient with coronary artery disease newly started on a TCA	Perform an ECG within 3 mo before initiation	Pacemaker	70	30	42.9
Patient with depression changing from an SSRI to MAOI therapy	MAOI started a specified time after stopping SSRI	–	5	4	80.0
Patient with depression changing from a MAOI to SSRI therapy	SSRI started a specified time after stopping MAOI	–	34	11	32.4
Patient with diabetes	Perform a hemoglobin A1C at least every 12 mo	–	26,494	11,195	42.3
Patient with diabetes without renal insufficiency	Perform an annual test for proteinuria	Receiving ACEI, ARB	14,134	5068	35.9
Patient with diabetes	Eye examination every 2 yr	Blind	23,380	12,026	51.4
Patient with diabetes and proteinuria	Prescribe ACEI or ARB	ACEI, ARB exclusions	18,253	17,843	97.8
Patient with heart failure	Prescribe ACEI or ARB	ACEI, ARB exclusions	37,177	17,749	47.7
Patient with new heart failure	Perform chest x-ray, ECG, CBC, serum electrolytes, and TSH	–	11,226	3076	27.4
Patient with new heart failure	Evaluate left ventricular ejection fraction within 1 mo	–	11,226	1585	14.1
Patient with heart failure	Prescribe a β blocker	β blocker exclusions	14,927	3773	25.3
Patient with heart failure without atrial fibrillation	Do not prescribe 1st or 2nd generation calcium channel blocker	–	22,433	21,843	97.4
Patient with heart failure	Do not prescribe a type 1 antiarrhythmic	ICD in place	35,287	34,957	99.1
Patient with newly diagnosed hypertension	Perform ECG within 4 wk of diagnosis.	–	16,200	5760	35.6
Patient with hypertension and renal insufficiency or proteinuria	Prescribe ACEI or ARB	ACEI, ARB exclusions	16,515	6500	39.4
Patient with hypertension and asthma	Do not prescribe β blocker	–	15,834	12,321	77.8
Patient hospitalized for AMI	Perform assessment of LVEF within 3 d of hospital discharge	–	2580	1787	69.3
Patient with AMI or unstable angina	Perform stress test within 4 to 21 d	–	2802	530	18.9
Patient with AMI or unstable angina and persistent ischemia	Perform cardiac catheterization	–	5221	1628	31.2
Patient with known CAD and unknown lipids	Check lipids	–	13,321	4140	31.1
Patient with CAD and hypercholesterolemia	Prescribe cholesterol-lowering medication	–	36,363	17,308	47.6
Patient with history of AMI	Prescribe β blocker	β-blocker exclusions	5260	1949	37.1
Patient prescribed warfarin	Check INR within 4 d of initiating medication and every 6 wk thereafter	–	4218	3297	78.2
Patient prescribed thiazide or loop diuretic	Check electrolytes yearly	–	40,866	35,631	87.2
Patient with diabetes	Do not prescribe chlorpropamide	–	16,971	16,715	98.5
All patients	Do not prescribe medications with strong anticholinergic effects if alternatives are available	–	100,528	84,248	83.8
All patients	Do not prescribe barbiturate medications	Seizure disorder	95,639	92,387	96.6
All patients	Do not prescribe meperidine	–	100,528	100,340	99.8
Patient prescribed ACEI or ARB	Check serum potassium and creatinine within 4 wk of initiation	–	22,083	4779	21.6
Patient treated with warfarin, history of PUD or GI bleeding, AND treated with NSAIDS	Prescribe misoprostol or a proton pump inhibitor medication	–	37,136	8735	23.5
Female patient newly diagnosed with osteoporosis	Prescribe bisphosphonates, SERM, calcitonin, PTH or HRT within 3 mo	–	6678	2628	39.4
Atrial fibrillation in high risk patient	Prescribe anticoagulant	–	20,370	4693	23.0
All patients	Perform eye evaluation every 2 yr	–	76,804	37,118	48.3
Patient with open angle glaucoma	Perform comprehensive eye examination	–	11,430	3653	32.0
Patient with diabetes and proliferative retinopathy	Perform dilated eye examination every 4 mo	–	1487	319	21.5
Patient with macular degeneration	Perform dilated eye examination every 6 mo	–	2300	888	38.6
Patient had cataract surgery	Perform follow-up ocular examination within 3 mo	–	6971	1115	16.0

ACEI indicates angiotensin converting enzyme inhibitor medication; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker medication; B12, vitamin B12; CAD, coronary artery disease; CBC, complete blood count; ECG, electrocardiogram; ECT, electroconvulsive therapy; GI bleeding, gastrointestinal bleeding; HRT, hormone replacement therapy; CD, internal cardiac defibrillator; INR, international normalized ratio; LDL, low density lipoprotein; LVEF, left ventricular ejection fraction; MAOI, monamine oxidase inhibitor; NSAID, nonsteroidal antiinflammatory drug; PPI, proton pump Inhibitor; PTH, parathryoid hormone; PUD, peptic ulcer disease; SERM, selective estrogen receptor modulator; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; TSH, thyroid stimulating hormone.

Exclusions: β blocker, bradycardia, heart block, asthma, COPD, or β-Blocker intolerance; ACEI/ARB, renal artery stenosis, renal failure, hyperkalemia, angioedema, or ACEI/ARB intolerance.